Post on 25-Apr-2022
Generations at Risk:
Exposure to Toxic
Environmental Agents and
Reproductive Health
Linda C. Giudice, MD, PhD
President
American Society for Reproductive Medicine
October 2, 2013 Washington, DC
Congressional Briefing
Exposed: The Environment and The Health of Our Most Vulnerable.
A panel discussion with the nation’s leading physicians
dedicated to the health of women, infants and children
American Society for Reproductive Medicine
2
ASRM is a multidisciplinary organization
dedicated to the advancement of the art,
science, and practice of reproductive medicine.
The Society accomplishes its mission through
the pursuit of excellence in education and
research and through advocacy on behalf of
patients, physicians, and affiliated health care
providers.
The Society is committed to facilitating and
sponsoring educational activities for the lay
public and continuing medical education
activities for professionals who are engaged in
the practice of and research in reproductive
medicine.
ACOG/ASRM Committee Opinion
“Environmental exposures can have a profound
and lasting impact on the health of our patients and
future generations”
Trends in
reproductive
function,
cancers, and
developmental
disorders
Age of menarche in Europe and the US from 1790 to 1980
Euling, S. Y. et al. Pediatrics 2008;121:S167-S171
Aggressive
Breast Cancer in
Young Women
2013
an increase in Aggressive breast cancer in young women - http://jama.jamanetwork.com/article.aspx?articleid=1656255
Human Disease Trends
Past (solid lines) and projected (dashed lines)
overweight rates in selected Organization for
Economic Co-operation and Developing countries 2012.
• Obesity
• Cardiovascular
disease
• Diabetes
• Metabolic syndrome
• Many of these diseases are
increasing in incidence, some
globally.
Rates of Preterm Delivery
IOM Report, Preterm Birth: Causes, Consequences, and Prevention 2008
• 1 out of 8 babies is born prematurely.
• Rate has increased 36% since the early 1980s.
Graph from Reproductive Roulette, http://www.americanprogress.org/issues/2009/07/reproductive_roulette.html. Source:
Stephanie J. Ventura et al, “Estimated Pregnancy Rates by Outcome for the United States, 1990–2004,” National Center
for Health Statistics, National Vital Statistics Reports 56 (15) (April 14, 2008); Stephanie J. Ventura et al., “Trends in
Pregnancies and Pregnancy Rates by Outcome: Estimates for the United States, 1976–96,” National Center for Health
Statistics, Vital and Health Statistics 21 (56) (January 2000).
Childhood Cancer
From 129 to 167 cases per million
children
Autism
From 6.4 to 11.4 cases per 1000
What has changed?
Exposure to environmental chemicals is implicated in adverse trends in reproductive and developmental
health
U.S. Chemical Production
0
20
40
60
80
100
120
1945 1955 1965 1975 1985 1995 2005
Year
Pro
du
cti
on
(10
0=
20
02
pro
du
ctio
n)
Federal Reserve G.17
13
Chemical production has increased 15-fold over 70 years
Today
84,000 chemical substances registered for use in U.S. commerce
3,000 chemicals used or imported in excess of 1 million pounds
700 new industrial chemicals introduced into commerce each year
Evidence that connects exposure to toxic environmental chemicals is robust
Diamanti-Kandarakis E et al. 2009
Endocrine-Disrupting Chemicals: An
Endocrine Society Scientific Statement.
Endo Rev 30(4):293-342
Evidence for adverse reproductive
outcomes (infertility, cancers,
malformations) from exposure to
endocrine disrupting chemicals is
strong, and there is mounting
evidence for effects on … thyroid,
neuroendocrine, obesity and
metabolism, and insulin and
glucose homeostasis.
President’s Cancer Panel
“… to a disturbing
extent babies are born
‘pre-polluted’”
17
2008–2009 Annual Report President’s
Cancer Panel
REDUCING
ENVIRONMENTAL
CANCER RISK
What We Can Do Now
The human reproductive system is vulnerable to harm from chemicals in
the environment
Timing Matters
Timing Matters
No increased risk of breast
cancer
5 fold
increased
risk of breast
cancer
Cohn et al. EHP 2007
ACOG/ASRM
Opinion:
“An important
outcome of
pregnancy is no
longer just a healthy
newborn but a
human being
optimally
programmed for
health from infancy
through old age.”
Recommendations
“… encourage women in
the preconception period
and women who are
pregnant and lactating to
eat fruit, vegetables, beans,
legumes … and avoid
these [high in mercury]
fish”
Recommendations
“Advancing policies and
practices in support of a healthy
food system should be pursued
as a primary prevention strategy
to ensure healthy pregnancies,
healthy children and healthy
future generations.”
Recommendations
“A chemical should never be
released if a concern exists
regarding its effect on health.”
Safer alternatives to toxic
chemicals protect workers,
communities and individuals at
home and abroad